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Deeper Worries in America

I worry about the coronavirus. It’s already killed more than 100,000 Americans. The recent protests have created a nerve-wracking public-health situation for the next weeks.

I really worry about racism. Not only racism in police systems but more systemic racism in our culture.

My friend Dr. Andrew Foy sent me this slide and post showing the large disparity in black and hispanic representation in medical education.

There can be no rest so long as a man like Dr. Otis Brawley, a distinguished professor of medicine,

“can get thrown to the ground, handcuffed and questioned at gunpoint for looking suspicious in a nice part of Montgomery County. That would be yours truly a few years ago.

My real offense: standing in the garage of my own home.”


But I think there may be another great threat to this country.

Last night I read a story describing a situation in which the writer Andrew Sullivan would not be allowed to publish his column on the protests in the New York Magazine.

Sullivan is not just forbidden from writing for the New York magazine about the riots; his contract means he cannot write on the topic for another publication.

From Wikipedia: Andrew Sullivan is an openly gay Roman Catholic conservative intellectual. He has voted for Bill Clinton, and endorsed Barak Obama. And in 2006, Sullivan was named as an LGBT History Month icon.

The reason I am writing here is that my colleague in cardiology Usman Qayyum asked ….with so many problems right now, how is this important?

This is important because it indicates what could become a dangerous problem: the fall of classic liberalism.

If a sane calm intellectual like Andrew Sullivan can be silenced, what does that say for others?

Then there was the civil war within the NYT about the Tom Cotton editorial. I disagree strongly with the Senator’s view, but as a leading senator, should he not be allowed to make his argument?

Intolerance of ideas also extends into science:

Liz Neporent, the social media director at Medscape, had an important story on how YouTube initially removed a video on coronavirus from British oncologist and former chief of The WHO for violating guidelines. Initial efforts to have the video reinstated failed. It took more intervention from Medscape Medical News to get it put back up.

What was the problem? The scientist dared to express a view of the coronavirus that ran counter to the prevailing “consensus.” As if there could be any consensus with a months-old novel virus.

Hospital-employed doctors and nurses have grown used to not speaking publicly on anything contentious. So have many corporate workers.

But when this degree of illiberalism reaches the opinion pages of media, college campuses or social medial platforms, we have a big problem.

The obvious issue with deplatforming an idea is that if it can’t be debated, it cannot be proven wrong.

The late Christopher Hitchens, who we dearly miss now, once said or wrote: “time spent in argument is hardly ever time wasted.”

If the opposition to the current authoritarian regime, one that seeks to divide us, is an illiberal group that does not tolerate free public debate, I think we should be very worried.


P.S. After a thoughtful online discussion with Professor Alok Khorana, I have changed my choice of words in the seventh and eleventh paragraphs.

In the seventh paragraph, I changed the wording from ‘even greater ‘ to ‘another’ to define a threat to our country. In the eleventh paragraph, I changed ‘what could become a much more dangerous problem’ to ‘what could become a dangerous problem.’

By expressing my concern over the intolerance of ideas in policy and science, I did not intend to minimize racism.

P.P.S: Another edit. I cut the line “As a doctor, I am always looking for upstream causes of bad things.” I did not mean to imply the intolerance of ideas caused systemic racism.

16 replies on “Deeper Worries in America”

America has become the only place where, in a foreign caused virus pandemic, the Wuhan…ahem, I mean COVID-19 virus, you can be arrested and threatened for not wearing a facemask or wanting to open your small business while Walmart can sell what you can’t… and neighbors are encouraged to “turn you in” for your “infractions”… and then in a country of 331 million, a high profile murder becomes a “proof” of systemic racism justifying destroying and looting white and minority small businesses, all while not wearing face masks and not honoring social distancing. And then a large contingent of the medical community says it’s okay because police “institutional racism” is a bigger medical concern than the pandemic, even though the numbers don’t bear that out. No wonder increasing numbers of people stopped listening to the medical community, news media, and universities far left political bias. Most frightening of all for me as a person with afib, is watching the presumptive democrat candidate for President, a person who has had atrial fibrillation for 17 years and is now chronic, act like he has dementia, even though he has been on an anticoagulant and who has the best medical care available. What a world. Gotta go, I want to read what the WHO is changing their minds about this week concerning person to person transmission of the virus and effectiveness of wearing masks. These are not trustworthy folks, folks.

Even more concerning may be the politicization of research published in scientific journals. Look at the Lancet’s recent misbehavior: major data errors and the lack of an ethics review in the hydroxychloroquine study published on May 22 coupled with its editorials urging Americans to vote against President Trump in the upcoming election.

Mr. Trump’s critics then seized on the Lancet study even though obesity and smoking rates in the study were the same across six continents, there was aggregation of patients who were different in many ways
– including HCL dosages and the severity of illness, Lancet had broken its promise to share all data and code on Covid studies, one of the study’s authors claimed his hospital contracts did not allow the data to be shared, and the many questions about how it obtained so many patient records from around the world given the privacy and technical challenges.

Although Lancet later published an “Expression of Concern” about the study and said it would undergo “an independent data audit,” its publication had already inflicted its intended damage.

Perhaps one could start with not blocking opposing views on Twitter and not removing opposing comments on Medscape.

Hydroxychloroquine is not an effective treatment for COVID-19.
Which means, of course, that it never was. You cannot change cause and effect by owning interest, releasing “news” or personally advocating. Observational studies are, at their best, only a possible indication that something of interest might be looked at further with an RCT.
Randomized Controlled Trials conducted on strict principle is the way to know.
Now we know.

That’s nothing to celebrate and there are more moving parts to the issue, for example, doctors themselves taking the hydroxychloroquine, stockpiling the drug for their families, and evidence that it DOES work when administered early in the correct doses for select patients. My wife’s cousin is an example of someone who had a huge turnaround after being put on the drug.

I think the quickest way to get positive results on hydroxychloroquine trials/studies and get FDA approval, would be to have President Trump say the drug is bad.

Precisely my point. (Did you read my comment above?) And so when severely problematic studies are retracted – one of which was baldly anti-Trump – it most certainly is reason to celebrate. It’s bad enough when one follows the money.

Anecdotes can tell you nothing certain, even though they may have good entertainment value.
The cousin might well have turned around anyway. There’s no way to know.
Doctors are human and subject to fears as well, but wishful thinking cannot be a guide to Reality.
Do you NOT think that RCTs should guide?

The problem with RCTs is they are often flawed and have limitations for a host of reasons including bias. I’m out of this discussion as it has become political.

The WHO has screwed up again. They said in March it was okay to travel and downplayed a COVID-19 pandemic. Now they said that asymptomatic patients are not likely to spread the disease. Oops, they walked that statement back. They changed their minds very late concerning effectiveness of masks.

These people are pathetic. I don’t listen to them

John, what you are observing is the inevitable effect of increasing polarisation in society, amplified many-fold by social media.

For example, it used to be possible to have rational discussion about vaccinations. Should my kids get them or not? Obviously there are risks associated with vaccination, just as there are with crossing the road to get my KFC. Wouldn’t it be great to be flush out these risks and discuss them? Perhaps children and adults alike could start to think scientifically about whether to get their vaccinations on not, and understand why?

You can still do that around the kitchen table and with friends. But any discussion on social media is doomed. It will degenerate as the anti-vaxxers join in, then further as the anti-anti-vaxxers arrive.

Some people love that kind of ding dong on the internet – others seek out safe places, like moderated forums, which removes the trolls, but of course then becomes an echo chamber of the like minded.

Either way, rational discussion and debate is doomed.

Who knows how much worse this polarisation can get in US society. Perhaps we are at one end of the pendulum’s swing – though with a president actively stoking polarisation, maybe there’s even further to go. Nobody knows.

John, I like what you write – thoughtful and measured. Congratulations for revising/softening some of your more dogmatic statements.
I’m afraid that discussion on the internet and even on sites like yours gets polarized quickly though.
This early in the development of thoughts on something entirely new, extreme views MAY have some grounds.
Would that we can keep discussions on topic and not go off on a tangent.

Keep writing. I’ll keep reading

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